Superfluid Fraction in an Interacting Spatially Modulated Bose-Einstein Condensate.

At zero temperature, a Galilean-invariant Bose fluid is expected to be fully superfluid. Here we investigate theoretically and experimentally the quenching of the superfluid density of a dilute Bose-Einstein condensate due to the breaking of translational (and thus Galilean) invariance by an external 1D periodic potential. Both Leggett's bound fixed by the knowledge of the total density and the anisotropy of the sound velocity provide a consistent determination of the superfluid fraction. The use of a large-period lattice emphasizes the important role of two-body interactions on superfluidity.

Management of COVID-19 ICU-survivors in primary care: - a narrative review.

Many survivors of critical illness suffer from long-lasting physical, cognitive, and mental health sequelae. The number of affected patients is expected to markedly increase due to the COVID-19 pandemic. Many ICU survivors receive long-term care from a primary care physician. Hence, awareness and appropriate management of these sequelae is crucial. An interdisciplinary authorship team participated in a narrative literature review to identify key issues in managing COVID-19 ICU-survivors in primary care. The aim of this perspective paper is to synthesize important literature to understand and manage sequelae of critical illness due to COVID-19 in the primary care setting.

[Empirical health services research in emergency and acute medicine : Preliminary results of concomitant monitoring of patient recruitment and sample quality]. / Empirische Versorgungsforschung in der Notfall- und Akutmedizin : Erste Ergebnisse eines begleitenden Monitorings zur Patientenrekrutierung und Stichprobenqualität.

BACKGROUND: Up until now, research data on the implementation of empirical health services research in emergency departments in Germany are scarce. STUDY AIM: A monitoring instrument applied in a multicenter prospective cohort study in emergency departments (EDs) is described and discussed regarding requirements for the control and supervision of data collection. MATERIALS AND METHODS: Patients with cardiac diseases, respiratory tract infections, and hip fractures were recruited in eight EDs located in a central district of Berlin. Enrolment figures and nonresponder reasons were analyzed through descriptive statistics. Potential sample bias was examined in terms of response rates as well as the distribution of age and sex in the group of participants and nonresponders. Qualitative content analysis was applied to data from routine supervisory and feedback meetings with study nurses. RESULTS: Within the first 8 months of data collection, 61.1% of the aimed 1104 patients were recruited. Most frequently stated nonresponder reasons were the dense work and care processes in EDs (41.9%) and patients' disease burden (24.7%). Moreover, qualitative results revealed problems with identifying potentially eligible participants and difficulties because of missing research infrastructure in study centers. The response rate of 50.7% and approximately equal distribution of age and sex in participants and nonresponders do not indicate sample biases. DISCUSSION: The monitoring instrument has proven to be suited for empirical research in EDs and revealed optimization potential. We recommend using qualitative and quantitative data systematically.

[GPs' Views on Barriers and Preconditions for Referring Elderly People with Depressive Disorder to Psychotherapy]. / Hindernisse und Voraussetzungen für die Vermittlung älterer, depressiv erkrankter Menschen in Psychotherapie aus Sicht von HausärztInnen.

OBJECTIVE: Older people with depressive disorders access psychotherapy less frequently than younger ones. GPs play an important role in referring patients, particularly the elderly, to psychotherapeutic treatment. This paper presents the obstacles to and preconditions for referring older, depressed sick people to psychotherapy from the point of view of GPs. METHODOLOGY: Doctors who are training GPs were given a questionnaire on the care of the elderly (60+) with depressive disorders. In 2 open questions, they were requested to state their views on obstacles to and preconditions for referring older, depressed diseased people to psychotherapeutic treatment. RESULTS: Most statements related to obstacles perceived by patients followed by barriers on the part of the supply system. Especially obstructive attitudes and emotions, but also functional limitations on the part of patients were referred to as barriers. With regard to the supply system, structural aspects, such as lack of psychotherapy places, but also the actions of care providers and insufficient cooperation were listed. As preconditions, specific therapy for the elderly were mentioned CONCLUSIONS: Dealing with reservations about psychotherapy on the part of older people takes time, which usually is not reimbursed in general practice. Collaborations with psychotherapists are seen as an important precondition for referral. Especially for people with multiple illnesses, access is considered difficult.

[Ambulatory care of patients with somatically unexplained complaints : A comparative qualitative study]. / Die ambulante Betreuung von Patienten mit somatisch nicht erklärten Beschwerden : Eine vergleichende qualitative Studie.

BACKGROUND: The aim of this study was to compare the approach of general practitioners (GP) and outpatient specialists for psychiatry, neurology or psychosomatic medicine to patients with somatically unexplained complaints. METHODS: Qualitative interviews were conducted with general practitioners in Berlin and with outpatient specialists. Interviews were analyzed by qualitative content analysis. RESULTS: Both GPs and specialists rarely used structured diagnostic instruments. Guidelines are seen and used with reservation throughout the different specialties. Similar to the GPs, most of the specialists surveyed in this study had reservations against the necessity of a precise coding according to the International Classification of Diseases (ICD). CONCLUSION: In outpatient care the concern for the individual patient is the connecting element between different medical specialties. This results in a differential diagnostic and therapeutic approach that is not automatically in line with guidelines. The development of common concepts in ambulatory care might help to meet the demands of this complex group of patients with somatically unexplained complaints.

[Primary Prevention in General Medical Practice: A Survey]. / Primärprävention in der Allgemeinarztpraxis: Eine Befragung.

AIM OF THE STUDY: According to the German social insurance code §20 Sec. 1, statutory health insurance companies can reimburse up to 80% of costs incurred by primary prevention programs in physical activity, nutrition, stress management and drug consumption. Whether and how many general practitioners (GPs) provide their patients with information on such programs as part of their own practice is unknown. In this study, we investigate to which primary prevention programs primary care physicians refer their patients and whether they take into account reimbursability of programs. METHODS: Between November 2010 and February 2011, all GPs with a practice in Berlin (n=1 168) received a questionnaire that assessed if patients were referred to prevention programs and the type of programs they were referred to, if they ensured they are reimbursable and if they themselves offered prevention programs. Descriptive statistics and multivariate logistic regression was used for analysis. RESULTS: Of 474 respondents (response rate: 41%), 67% were female. Of the respondents, 22% offered reimbursable prevention programs and 42% at out-of-pocket expense. Patients were referred to reimbursable programs by 63%. GPs younger than 50 were twice as likely to offer reimbursable programs in their practice compared to those older than 50 (OR=1.7; 95% KI 1.1-2,8; p-value 0.025). CONCLUSION: A successful implementation of the new German prevention law needs awareness among GPs about reimbursable prevention programs, which may be lacking in some groups.

[GPs' Perceptions of Strengths and Shortcomings of the ICD-10 for Diagnosis of depression]. / Stärken und Schwächen der ICD-10 bei der Depressionsdiagnostik aus Sicht von HausärztInnen.

AIM: For the health care of people with depressive disorders, general practitioners are important contact persons. Some investigations have shown an under-diagnosis of these patients in GPs' surgeries. The significance of the ICD-10 for the diagnosis of depression is disputed. The BMBF-funded study "PSYTIA - Psychotherapy in old age" engages, among others, with the treatment of older people with depression in GPs' surgeries. This study presents the strengths and shortcomings of the ICD-10 for diagnosis of depression from the point of view of GPs. METHODS: With the help of a questionnaire, 402 teaching GPs were asked how they diagnose and treat elderly people (60+) with depressive disorders in their practices. The response rate was 23.6%. 2 open-ended questions dealt with GPs' perceptions of strengths and shortcomings of ICD-10 for the diagnosis of depression. The responses were matched to inductively developed overarching categories. RESULTS: About three-quarters of the respondents answered the 2 questions. While nearly one-fifth of the respondents did not state any opinion about the suitability of ICD-10 as a diagnostic instrument for depressive disorders, 41% of the respondents mentioned the shortcomings and one-third the strengths of ICD-10. Shortcomings and strengths relate primarily to the complexity of the instrument and its manageability in everyday practice. CONCLUSIONS: The results show that application of ICD-10 in a GP's surgery depends on a holistic, hermeneutical approach to the case in family practice, a need for efficient practice management, and billing. These different perceptions explain the heterogeneous and ambivalent assessment of the suitability of ICD-10 for the diagnosis of depression.

Discharge management strategies and post-discharge care interventions for depression - Systematic review and meta-analysis.

BACKGROUND: Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be effective in preventing symptom deterioration and readmission. We aimed to evaluate the effectiveness of care transition interventions for patients with depression after psychiatric hospitalization. METHODS: Systematic review and random-effects meta-analysis of controlled trials. Primary outcomes were readmissions and symptoms of depression. The control condition was treatment as usual. RESULTS: We included 16 publications reporting the results of 13 different studies. Studies were heterogeneous concerning patient selection and interventional approach. Effects on readmissions and depression symptoms were non-significant in meta-analysis of 8 studies/710 patients and 7 studies/592 patients, respectively. Overall risk ratio for readmission during follow-up was 0.65 (95% CI [0.42;1.01], p=0.06), standardized mean difference for depression symptoms was -0.09 (95% CI [-0.37;0.19], p=0.53). Subgroup analyses indicated no preference for a specific interventional strategy. Data point to considerable risk for selection and publication bias. LIMITATIONS: Included studies are heterogeneous; subgroups are often small and may not attain the power to detect effects. Reasonable classification of interventions into groups of comparable approaches was a challenge and may be arbitrary in some cases. CONCLUSIONS: This systematic review and meta-analysis could not identify any convincingly effective interventional transition approach for patients with depression after psychiatric hospitalization. Current evidence regarding discharge management for depression is limited, heterogeneous and potentially prone to bias. Interventions might be more appropriate for patients with other diagnoses than depression. Further high-quality randomized studies are required.

[Preventive advice-giving: self-assessment of general practitioners in Brandenburg]. / Präventive Beratung: Selbsteinschätzungen Brandenburger Hausärzte.

INTRODUCTION: Improving individual health behaviour is a promising approach especially in cardiovascular prevention. In general practice, preventive advice-giving is hitherto put into practice insufficiently. The study explores which role general practitioners are willing and able to play in behaviour-oriented prevention. METHODS: 50% of general practitioners in Brandenburg (n=748) were randomly selected for the study. A standardised questionnaire was mailed to them in which their attitudes towards preventive advice-giving were measured using Likert scaling. Participation was anonymous. RESULTS: 37% of the physicians answered the questionnaire. Almost all of them see it as their responsibility to inform patients about possible reduction of lifestyle-dependent health risks and to motivate them accordingly. Self-assessment concerning advisory skills is predominantly positive (best for physical activity, worst for smoking cessation and sexual risk behaviour advice). Time resources for behaviour-oriented prevention are sparse. For this reason, the delegation of many advisory tasks to physician assistants is regarded positively. CONCLUSION: Most physicians see themselves as willing and able to perform behaviour-oriented prevention. Nevertheless, realising this task seems to be difficult, e. g., concerning the frame conditions of general practice. The role of general practitioners in prevention and health promotion should be defined more accurately.

Counseling overweight patients: analysis of preventive encounters in primary care.

OBJECTIVE: The increasing prevalence of obesity requires particularly primary care providers to take action. The aim of this study was to analyze general practitioners (GPs) encounters with overweight and obese patients in primary care to test the hypothesis that patients with a BMI ≥ 30 kg/m² would have longer consultations focusing on lifestyle-related issues like nutrition and physical activity than those with a BMI < 30 kg/m². DESIGN: Cross sectional comparison of audiotaped encounters of patients with a BMI ≥ 30 kg/m² and those with a BMI < 30 kg/m². SETTING: Twelve GP surgeries in Berlin, Germany. PARTICIPANTS: Fifty patients who agreed to have preventive check-up encounters audiotaped. MAIN OUTCOME MEASURES: Based on the Roter Interaction ANALYSIS: System (RIAS) we assessed duration of encounter and the prevalence of GP statements regarding cardiovascular risks, nutrition and physical activity. RESULTS: An increased BMI was found to be a predictor for the length of encounters (P = 0.01), whereas the content of talks was mainly determined by the individual of GP and sex of the GP. Statements regarding cardiovascular risks were most frequent, followed by those regarding nutrition and physical activity. In this study the assessed physiological parameters were not associated with the specific contents of preventive encounters like nutrition or physical activity (P > 0.05). CONCLUSIONS: Our results indicate that GPs rarely use the check-up program to conduct lifestyle consultations with obese patients. Barriers to lifestyle counseling and possible solutions are discussed with a view to promoting individualized and target management of overweight patients.

[Unresolved problems of undocumented migrants in Germany: an analysis of medical consultations in Berlin, Cologne and Bonn]. / Problemlagen von versteckt lebenden Migranten in Deutschland: Analyse der medizinischen Beratungsanlässe in Berlin, Bonn und Köln.

INTRODUCTION: Little is known about health related problems of undocumented migrants in Germany. Patterns for medical consultations and socio-demographic characteristics are only available in isolated reports. This article identifies and compares empirical data from non-governmental organisations (NGOs) who provide medical care for unregistered migrants. METHODS: Annual reports of 2006 and 2007 of the Malteser Migranten Medizin (Berlin, Cologne) and the MediNetz Bonn were selected for this document analysis. RESULTS: We identified similarities and differences in the socio-demographic background and patterns of medical consultations between the explored regions. The number of documented migrants without medical insurance increased during the observed period. DISCUSSION: The patterns of health-care utilisation for undocumented immigrants changed in the observed period which might be caused by the EU enlargement to the East. The heterogeneous quality of the annual reports and the lack of information about the use of alternative health-care facilities limit the results of this analysis.

[The significance of rebiopsy in the diagnosis of prostate cancer]. / Stellenwert der Rebiopsie in der Diagnostik des Prostatakarzinoms.

OBJECTIVE: The objective of this study was to evaluate whether rebiopsy of the prostate leads to a significant increase in the detection rate of prostate cancer compared with performing a single biopsy. METHODS: Data from 406 patients were evaluated retrospectively. The patients had undergone ultrasound-guided transrectal biopsy of the prostate between January 2004 and August 2005. Besides demographic data, the patient information was reviewed with regard to the number of biopsy samples taken per patient, histological results, and the occurrence of complications during or after the examination. If prostate cancer was detected, data acquisition included the number of positive biopsy samples taken per examination as well as the subsequent therapy and the TNM classification of the tumor. After a follow-up time between 24 and 42 months, all patients with a histologically negative first biopsy were reevaluated regarding rebiopsy. We evaluated the follow-up time (in months) and the histological results. If prostate cancer was detected, we assessed the number of positive biopsy cores as well as the subsequent therapy and the TNM classification. RESULTS: In 37.7% of all patients (n=153), prostate cancer was detected in the first biopsy. In 56.9% of these (n=87), a high-grade carcinoma with a Gleason score >or=7 was diagnosed. In 108 patients, a second biopsy was performed. The mean time between the first biopsy and rebiopsy was 21.7 months (range 1.3-41.2 months). With the second biopsy, prostate cancer was detected in 29 cases (26.9%), of which 51.7% (n=15) showed a high-grade carcinoma. There was no significant difference between the first biopsy and the second biopsy concerning either the detection rate of carcinomas related to the total number of transrectal multibiopsies or the detection of high-grade carcinomas related to the number of detected carcinomas. Provided that values beyond the second standard deviation were excluded from analysis, prostate-specific antigen (PSA) values at the time of rebiopsy were significant elevated compared with PSA values at the time of first biopsy. More than two-thirds of all patients with a histologically positive result in the second biopsy revealed a PSA velocity >or=0.6 ng/ml/year. Furthermore, there was no significance between the number of histologically positive samples per multibiopsy when prostate cancer was diagnosed in the first biopsy compared with the number of positive samples in the second biopsy. Complications after biopsy were noted in 19 patients. In three cases, hospitalization was necessary. CONCLUSION: As a result of performing a rebiopsy, the detection rate of prostate cancer increased significantly compared with the detection rate after a single biopsy. Thus, the number of patients who could receive therapy was also increased. Due to the relatively low complication rate of prostate multibiopsy, this examination can be widely indicated. There was not a higher detection rate of high-grade prostate cancer in the second biopsy compared with performing only a single biopsy. The indication for a second biopsy as well as the determination of the time interval between the first and second biopsy should consider the current PSA value and PSA dynamics. Therapeutic consequences should also be taken into consideration. In the event of a PSA velocity >0.6 ng/ml/year, a rebiopsy should definitely be performed.

What do community-based dengue control programmes achieve? A systematic review of published evaluations.

Owing to increased epidemic activity and difficulties in controlling the insect vector, dengue has become a major public health problem in many parts of the tropics. The objective of this review is to analyse evidence regarding the achievements of community-based dengue control programmes. Medline, EMBASE, WHOLIS and the Cochrane Database of Systematic Reviews were searched (all to March 2005) to identify potentially relevant articles using keywords such as 'Aedes', 'dengue', 'breeding habits', 'housing' and 'community intervention'. According to the evaluation criteria recommended by the Cochrane Effective Practice and Organisation of Care Review Group, only studies that met the inclusion criteria of randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after trials (CBA) or interrupted time series (ITS) were included. Eleven of 1091 studies met the inclusion criteria. Of these, two were RCTs, six were CBAs and three were ITS. The selected studies varied widely with respect to target groups, intervention procedures and outcome measurements. Six studies combined community participation programmes with dengue control tools. Methodological weaknesses were found in all studies: only two papers reported confidence intervals (95% CI); five studies reported P-values; two studies recognised the importance of water container productivity as a measure for vector density; in no study was cluster randomisation attempted; and in no study were costs and sustainability assessed. Evidence that community-based dengue control programmes alone and in combination with other control activities can enhance the effectiveness of dengue control programmes is weak.